1. Field of the Invention
The present invention relates to a device and method for spreading adjacent tarsal bones to facilitate surgical procedures within the joint space. More specifically, the present invention relates to a distractor device shaped and configured to allow unimpeded access to joint spaces and articular surfaces when approached from dorsal, dorsolateral, or dorsomedial surfaces of the foot. Additionally, the device may be utilized for compression of osseus fragments in achieving internal fixation of small bones that have been fractured.
2. Preliminary Discussion
Foot pain and difficulty in walking are frequent complaints and may result form a wide variety of conditions. Traumatic, septic, or osteoarthritic degeneration of a joint may produce a joint that is painful and debilitating. In other circumstances, connective tissue disorders or neurological derangements may lead to abnormalities of gait that make ambulation difficult. In many instances the most effective treatment may be surgery involving the joints of the foot ankle, namely the tarsal joints. Various surgical procedures are available and known to be effective to restore osseus architecture, eliminate motion at a painful joint, and create a more stable and functional lower extremity. In order to do this, the surgeon must be able to access the articular surfaces found within the joint spaces. During such podiatric surgical procedures, the tarsal joint spaces are most often approached dorsally, dorsomedially, or dorsolaterally. The actual articular surfaces are found between the tarsal bones, and are the focus of many of these procedures. These bones must be separated and held in the retracted position while the surgeon performs various aspects of these procedures including but not limited to denuding of articular cartilage, subchondral drilling, feathering of articular surfaces, and resection of osseus fragments. In these circumstances, the surgeon must insert various instruments into tarsal joint spaces and must utilize some device to hold the joint space open. The present invention relates such a device, for spreading apart adjacent tarsal bones to facilitate unobstructed access to the joint spaces and articular surfaces therein in order that the surgeon utilizing the device may be able to perform various surgical procedures within the joint spaces.
3. Description of Related Art
While previous devices have taken a variety of approaches in addressing the retraction of tissues in order to allow unfettered access to an operative site, the previously conceived devices in one way or another, by their designs impaired access to the articular surfaces by means of insertion of blades, arms, rakes or devices into the joint spaces. Other devices that may have attempted to improve on this concept and retract without inserting objects into the joint space retracted, still limited access to the operative site by bridging the space retracted. In either event, there is restriction of access to the joint space and articular surfaces retracted and operated upon in tarsal joint surgery.
In October 1888 Brown, with U.S. Pat. No. 390,561 Brown presented a device for retraction of tissues in dental procedures. This device utilized a pair of movable handles pivoted on a common pivot pin or hinge for reciprocal expansion or contraction when the handles are reciprocally moved. A pair of blades arranged at perpendicular angles to the shafts of the handles were to be inserted into the space being retracted. The configuration of this retractor is such that insertion of the blades at the distal ends of the retractor arms into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In October 1896 Roeloffs, with U.S. Pat. No. 569,839 proposed a retractor utilizing a spring leaf design with various interchangeable prongs or leaflets for insertion into the space to be retracted. While this device would be useful in the retraction of tissues in many procedures, the size and configuration of the various attachments necessarily inserted into the space being retracted is such that these distal ends of the retractor into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the distal aspects of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In October 1940 Radcliff, with U.S. Pat. No. 2,217,968 presented a pivoted retractor comprised of variously configured hinged opposed leaves to grasp and retract tissues. While this device would be useful in the retraction of soft tissues, the size and configuration of the teeth of this retractor is such that insertion of the distal ends of the retractor arms into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the distal aspects of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In November 1975 Peterson, with U.S. Pat. No. 3,916,907 presented a surgical retractor for use in spinal surgery having a pair of elongated members pivotally attached intermediate their ends. A primary embodiment of this invention was the partial-circularly shaped plates extending outward from adjacent opposite free ends of the respective members. The size and configuration of the ends of this retractor are such that insertion of the distal ends of the retractor arms into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In July 1977 Williams, with U.S. Pat. No. 4,034,746 presented a surgical retractor of the type having a pair of movable handles pivoted on a common pivot pin or hinge for reciprocal expansion or contraction when the handles are reciprocally moved. The size and configuration of this retractor is such that insertion of the distal ends of the retractor arms into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In July 1988 Cox, with U.S. Pat. No. 4,754,746 presented a retractor utilizing opposing jaws pivoted together and extend oppositely from handles manually swingable to move the jaws relatively toward and away from each other. Generally rectangular blades extend downward from the swinging ends of the jaws and have planar leading bottom portions contiguously engageable for fitting between closely adjacent bones such as metatarsals. The jaws are swung apart to spread the bones and maintain them in spread-apart condition for convenient access to the facing surfaces of the bones. In the case of tarsal joint surgery, this device would be ineffective because the size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In August 1990 Torre, with U.S. Pat. No. D309,946 presented a scissored hinge type retractor utilizing opposed u-shaped tongs designed to grasp metatarsal shafts and retract metatarsal heads. The curved ends of this device make it unsuitable for insertion into the tarsal joints for retraction.
In February 1990 Grundei, with U.S. Pat. No. 4,898,161 presented a scissor hinged type vertebral retractor utilizing pins as the means of engaging adjacent vertebral bodies to be retracted. With this device, the pins are parallel the distracting mechanism, and because they lie in the same plane, distraction of small tarsal bones with this device would require that some portion of the device bridge the distracted joint space, obscuring the view and partially blocking access to the space retracted.
In February 1991 Torre, with U.S. Pat. No. D314,826 presented a scissorred hinge type short bone retractor utilizing curved barrel sections to grasp and retract shafts of curved bones. The curved ends of this device make it unsuitable for insertion into the tarsal joints for retraction.
In May 1991 Torre, with U.S. Pat. No. D317,202 presented an ornamental design for a surgical bone retractor. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In May 1994 Byrne, with U.S. Pat. No. 5,307,790 presented a bracelet retractor assembly designed to encircle an extremity and retract skin and soft tissue of the incisional approach, but would be ineffective in applying the necessary force to retract tarsal joint without applying crushing type forces to surrounding soft tissues.
In October. 1994 Jung, with U.S. Pat. No. 5,351,680 presented a manual surgical retraction device suitable for retraction of soft tissue during procedures such as gall bladder surgery, but ineffective for the retraction of bone and joint spaces.
In June 1999 Farascioni et al., with U.S. Pat. No. D411,299 presented an ornamental design for a surgical retractor. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In July 1999 Farascioni et al., with U.S. Pat. No. D411,883 presented an ornamental design for a surgical retractor. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In August 1999 Sava, with U.S. Pat. No. 5,931,777 presented a tissue retractor comprising a pair of pivotally linked arms, each with a blade mounted thereto by a ball and socket joint to allow the blades free movement relative to the arms. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In August 1999 Koros et al., with U.S. Pat. No. 5,944,658 presented a lumbar laminectomy retractor and distractor system comprised of one or more retractor frames including retractor blades for placement in an incision. The blades can be placed in an incision and then engaged by a retractor frame to spread the incision for viewing the surgical site. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In September 1999 Johnson, with U.S. Pat. No. 5,957,836 presented a rotatable retractor instrument for expanding a body joint is disclosed. A flattened portion is provided at the distal end of the instrument. With the flattened portion inserted within the joint, rotation of a handle at the instrument's proximal end spreads the joint. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In November 1999 Graham, with U.S. Pat. No. 5,976,125 presented an external fixation apparatus for reduction and distraction of a joint injury such as fracture or dislocation of the proximal and distal bones of a joint from a location external to the soft tissue of a patient. This device included a proximal fixator, a distal fixator, a proximal wire inserted through the proximal fixator and into a proximal bone, a distal wire inserted through the distal fixator and into a distal bone, and an adjustable distraction mechanism connecting said proximal and distal fixators. This device is designed primarily for external fixation rather than internal distraction during surgery. Additionally, the distractor mechanism is somewhat cumbersome in its method of distraction further improved upon by the present invention with the incorporation of a dual axis screw actuated retractor arms facilitating distraction or compression.
In November 1999 DeFonzo, with U.S. Pat. No. D417,276 presented an ornamental design for a surgical retractor. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In January 2000 Bonutti, with U.S. Pat. No. 6,017,305 presented a fluid operated retractor, which may be used to spread a joint such as a knee joint, or a shoulder joint, or may be used to separate tissue planes generally, to improve visualization and create a working space for the surgeon. This retractor is useful in percutaneous fiber optic surgery, but by the nature of introduction of fluid to facilitate the creation of a working space, would be ineffective in open surgical procedure such as tarsal joint surgery.
In April 2001 Coker, with U.S. Pat. No. 6,214,004 presented a vertebral triplanar alignment facilitator to enable a surgeon to make minute vertebrae adjustments during spinal surgery. While well suited to spinal surgery, the size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In May 2001 Cocchia, et al., with U.S. Pat. No. 6,224,545 presented a surgical retractor apparatus comprising a U-shaped thread assembly slidably engaged with a U-shaped rack. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In June 2001 Bookwalter, et al., with U.S. Pat. No. 6,241,659 presented a surgical retractor assembly with controlled rotation comprising a blade mounted on a shaft having a controlled degree of rotation and swings down to grip and retract tissue from bone or a hard tissue structure. The size and configuration of this retractor is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the blades of the retraction device denying access to the very surfaces commonly operated upon during such procedures.
In February 2002 Scholihornal., with U.S. Pat. No. D453,377 presented an ornamental design for a retractor which would be ineffective as a retractor for tarsal joint surgery because the size and configuration is such that insertion into tarsal joint spaces would be cumbersome and the articular surfaces retracted would be obscured by the retraction devices denying access to the very surfaces commonly operated upon during such procedures.
There is a need, therefore, for a surgical retractor device that is effective in its ability to retract adjacent small osseus structures, such as tarsal bones, without inserting objects into the joint space, without blocking or covering the articular surfaces of the joint being operated upon, and without bridging or otherwise blocking access to the retracted space from a dorsal approach, in order to provide free and unfettered access for the surgeon to the articular surfaces of bones located within such a joint space when those surfaces are to be operated upon.
The present invention employs pre-existing technology with new application that overcomes the limitations of previously conceived inventions within the prior art.
A significant improvement of the present invention over existing devices is the application of a method of small joint space retraction in which adjacent bones are retracted without inserting objects into the joint space, without blocking or covering the articular surfaces of the joint being operated upon, and without bridging or otherwise blocking access to the retracted space from a dorsal approach.
The simplicity of this design contributes to the commercial viability of the product and is a substantial improvement over previous designs and as such, should decrease the operative time of various tarsal joint surgical procedures, thereby decreasing the time a patient undergoes anesthesia and hemostasis of the extremity, and should thereby decrease associated complications of such surgical procedures.